Nursing 302 Alterations of Hematological Function PDF

# Alterations of Hematological Function ## Nursing 302 ## Alteration in Platelet Count - Thrombocytopenia - Normal concentration of platelets is 150-400 x 10^9/L - Less than 150 = thrombocytopenia - Usually asymptomatic until less than 100 - Abnormal bleeding may occur in response to even...

# Alterations of Hematological Function ## Nursing 302 ## Alteration in Platelet Count - Thrombocytopenia - Normal concentration of platelets is 150-400 x 10^9/L - Less than 150 = thrombocytopenia - Usually asymptomatic until less than 100 - Abnormal bleeding may occur in response to even minor trauma - Less than 20 = _spontaneous_ major bleeding episodes **Causes:** Hypersplenism, autoimmune disease, hypothermia, viral or bacterial infections that cause disseminated intravascular coagulation (DIC) **Clinical Manifestations:** - Spontaneous petechiae (pinpoint) and purpura (larger, but bleeding of capillaries) - Bleeding from GI tract (melena, Frank blood) - Bleeding from GU tract (hematuria) - Bleeding from pulmonary mucosa (hemoptysis) - Bleeding from the gums **Treatment:** Correct underlying cause, platelet transfusion ## Heparin - Induced Thrombocytopenia (HIT) - "Fluke", an adverse reaction caused by heparin (usually IV heparin, but may happen with LMWH) - Immune-mediated, IgG antibodies destroy the platelets **Clinical Manifestations:** - Venous & arterial thrombosis - Refer to CM of thrombocytopenia on previous slide **Lab Values** for clotting times include PTT & INR - PTT for heparin - INR for warfarin ## Thrombocythemia - Thrombocythemia: a disease in which your bone marrow makes _too many_ platelets - Too many platelets makes it hard for your blood to clot normally - Microvascular thrombosis or hemorrhage occurs - Thrombocythemia is characterized by platelet counts >400 x 10^9/L - **Causes:** - Primary = overproduction of megakaryocyte cells - Secondary = after splenectomy as the platelets will have nowhere to go! ## Disorders of Coagulation ### Impaired Hemostasis - Usually caused by defects or deficiencies in one or more of the clotting factors - Some are inherited, hemophilias and von Willebrand's disease - Acquired defects include deficient synthesis of clotting factors by the liver - Liver disease - Dietary deficiency of Vitamin K (green leafy vegetables) ### Consumptive Thrombohemorrhagic Disorders - BOTH hemorrhagic and thrombotic pathological findings - Disseminated Intravascular Coagulation (DIC) ## Disseminated Intravascular Coagulation (DIC) - Complex, acquired disorder in which clotting and hemorrhage occur simultaneously - **Damage** to the vascular endothelium, therefore clot to fix damage - Fibrin clots formed in medium and small vessels - Blocks blood flow to organs → leading to multiple organ failure (kidney & lungs) - Consumption of platelets (where they don't need to be), can exacerbate bleeding from _other_ sources - Imbalance between the coagulant system and the fibrinolytic system **Etiology:** Sepsis, pregnancy complications, infections, trauma, liver disease, hypoxia **S/S:** Relating to hemorrhage or thrombosis - Bleeding from venipuncture sites & arterial lines - Purpura, petechiae, and _hematomas_ - Symmetrical cyanosis of the fingers and toes - Hypovolemic shock **Treatment:** Correct underlying cause, control ongoing thrombosis & maintain organ function ## Thromboembolic Disorders - Arterial or Venous Thrombi - **Virchow’s Triad...** - 1. - 2. - 3. - **Lab value =** - **Signs & Symptoms =** ## Idiopathic Thrombocytopenic Purpura (ITP) - Thrombocytopenia that results from immunologic platelet destruction - Acute (following a viral infection), or chronic (linked with immunological disorders) **S/S:** Manifestations associated with decreased platelets... **Diagnostic Tests:** Platelet count, bone marrow study **Treatment:** - IVIg (IV Immunoglobulin) infusion, suppresses anti-platelet antibodies ## Erythrocyte Deficiencies- ANEMIA - Anemia: reduction in the total number of RBC in the circulating blood, or a decrease in the quality or quantity of hemoglobin **Commonly result from:** - Impaired RBC production - Blood loss (acute or chronic) - Increased RBC destruction - Or _a combination_ of these _three_ factors - Classified by their causes or by the changes that affect the size, shape or substance of the RBC - Terms that end with -cytic refer to cell size - Terms that end with -chromic refer to hemoglobin content **Types we will be focusing on:** Macrocytic-Normochromic (Pernicious Anemia), Microcytic-Hypochromic Anemia, Sideroblastic Anemia, Normocytic-Normochromic Anemia ## Clinical Manifestations & Treatment of Anemias - **Main alteration** is reduced oxygen carrying capacity in the blood, leading to tissue hypoxia! - Hypoxemia (low O2 levels in the blood) _may further_ contribute to - Heart Failure (how?) - Respiratory symptoms (like?) - Impaired wound healing **Classic anemia symptoms:** - Fatigue - Weakness - Dyspnea - Pallor (reduced hgb) **Treatment:** - Underlying condition - Relief of symptoms - Blood transfusion - Dietary correction - Supplemental vitamins or iron ## Macrocytic-Normochromic Anemias - Characterized by large stem cells in the bone marrow that mature into unusually large RBC's - Ineffective DNA synthesis of the RBC caused by vitamin B12 deficiencies - Defective RBCs die prematurely (eryptosis) - Bilirubin released... leading to _jaundice_ ### Pernicious Anemia - Absence of intrinsic factor required for _gastric_ absorption of dietary B12; result from autoimmune gastritis → cannot absorb enough B12! - May also be secondary to a previous H. pylori infection ## Pernicious Anemia (Macrocytic-Normochromic Anemia) - Caused by a lack of intrinsic factor _from_ the gastric parietal cells, which is required for vitamin B12 absorption... results in vitamin B12 deficiency **Early symptoms:** nonspecific and vague **Late symptoms** (when hemoglobin at 70 to 80 g/L): - Weakness, fatigue, paresthesia - Loss of appetite, abdominal pain, weight loss, sore tongue - Jaundice & Right HF symptoms **Treatment:** Oral high oral doses of vitamin B12 & lifelong treatment ## Microcytic-Hypochromic Anemias - Characterized by RBCs that are abnormally small & contain reduced amounts of hemoglobin (less colour than normal) - Related to disorders of iron metabolism - Decreased oxygen carrying ability ### Iron Deficiency Anemia - Most common type of anemia worldwide - **S/S:** Fatigue, weakness, shortness of breath, _pale_ palms and conjunctiva ### Sideroblastic Anemia - Insufficient iron uptake; abnormal hgb synthesis - **S/S:** Same as iron deficiency anemia **Treatment:** would include increased dietary iron intake, or IV iron infusions ## Normocytic-Normochromic Anemias - Characterized by RBCs that are relatively normal in size & hemoglobin content _but_ insufficient in number - Aplastic (inability to generate mature blood cells) - Insufficient erythropoiesis likely autoimmune in nature **Clinical Manifestations:** - Hypoxemia - Pallor - Weakness - Fever - GI _bleeding_ - Purpura ## Erythrocyte Excess - Polycythemia: excessive RBC production - _Relative_: from a CAUSE (underlying condition) - Absolute AKA Polycythemia Vera ### Polycythemia Vera - Abnormal proliferation of bone marrow stem cells - Causes hypercoagulability... what are patients more prone to? - Etiology is _unknown_ ## Iron Excess - Hereditary Hemochromatosis: iron overload; autosomal recessive disorder of iron metabolism - Hemochromatosis is a disorder in which the body can build up too much iron in the skin, heart, liver, pancreas, pituitary gland, and joints. Too much iron is toxic to the body and over time the _high_ levels of iron can _damage tissues_ and organs. - **S/S:** fatigue, malaise, abdo pain, hepatomegaly, abnormal liver enzymes, cardiomegaly **Treatment:** management via diet → don't eat as much red meat ## Alterations of Leukocyte Function - Leukocytosis - _high_ WBC _count_ - Occurs with infection - Leukopenia – _low_ WBC count - Low white count... predisposes a patient to infections - _-philia_ = increased -_penia_ = reduced - Ex. increase of neutrophils = neutrophilia, decrease of neutrophils = neutropenia - Can be applied for all granulocytes (neutrophils, eosinophils, basophils) ## Infectious Mononucleosis (IM) "Mono” - Acute, self-limiting infection of B-lymphocytes transmitted by saliva through personal contact - Commonly caused by the Epstein-Barr virus (EBV) **Symptoms:** - Fever - Sore throat - Swollen cervical lymph nodes - Increased lymphocyte count **Serious complications:** are rare (splenic rupture) **Diagnostic test:** Monospot qualitative test for heterophilic antibodies **Treatment:** supportive with rest, analgesics and antipyretics ## Leukemias - Malignant disorder of the blood - Irregular production of WBCs that obstruct the bone marrow; preventing hematopoiesis - Pancytopenia all three cell lines (RBC, platelets, WBC)_ are LOW **Classified as:** - Acute vs. chronic (cell maturation at disease onset) - Type of leukocyte involved - Myelogenous vs. lymphocytic (arising in bone marrow or lymphocyte) ## Signs and Symptoms of Leukemia - Anemia - Bleeding - Petechiae, purpura, ecchymosis, hemorrhage - Infection - Weight loss - Bone pain - Elevated uric acid - Increased catabolism of protein and nucleic acid, dehydration - Liver, spleen, and lymph node _enlargement_ **Treatment** is chemotherapy, as well as supportive management including blood transfusions, antibiotics, stem cell transplants and bone marrow transplants ## Lymphadenopathy - Enlarged lymph nodes that become palpable and tender - _Local_ lymphadenopathy - Drainage of an area associated with an inflammatory process or infection (reactive lymph node) - General lymphadenopathy - Occurs in the presence of malignant or nonmalignant disease **Relevant finding** in Hodgkin's & Non-Hodgkin's Lymphoma ## Hodgkin’s Lymphoma - Characterized by the presence of Reed-Sternberg cells in the lymph nodes - Reed-Sternberg cells are necessary for diagnosis, but _they_ are not specific to Hodgkin's lymphoma **Physical findings:** - Adenopathy, mediastinal mass, splenomegaly, and abdominal mass **Symptoms:** - Fever, weight loss, night sweats, pruritus - Adult Hodgkin's lymphoma can usually be cured with early diagnosis and treatment **Treatment:** - Chemotherapy - Radiation - Surgery ## Non-Hodgkin's Lymphoma - Generic term for a diverse group of lymphomas, _based_ on cell type (T, B, NK) - Non-Hodgkin's lymphomas are linked to chromosome translocations **Risk factors:** include being older, male, or white, having certain immune disorders, HIV/AIDS, immunosuppression, a variety of environmental exposures, certain _viruses_, and a diet high in meats and fat. **S/S:** Multiple peripheral lymph nodes swollen, fatigue & weakness, fever, hepatomegaly, splenomegaly **Treatment** depends on type of cell involved; usually chemotherapy and radiation ## Multiple Myeloma - Malignant proliferation of plasma cells which infiltrate bone marrow and aggregate into tumour masses in skeletal system **S/S:** Skeletal pain which then further progresses to osteoporosis, hypercalcemia and symptoms of spinal cord compression; pancytopenia; renal failure **Diagnosed** by bone marrow biopsy, immunoglobulin levels (M protein), xray (bone erosion), Bence Jones protein (urine test) **Treatment** includes chemotherapy, medications to help protect bones, radiation therapy, pain management ## Alterations of Splenic Function **Functions of the spleen:** - Phagocytosis of blood cells - Antibody production - Storage of blood **Splenomegaly:** Enlargement of the spleen; may be _one_ of the first signs of an underlying condition - Overfilled with blood; susceptible to rupture! - Congestive Splenomegaly; accompanied by ascites, portal HTN and esophageal varices seen in hepatic cirrhosis **Hypersplenism:** Overactive splenic functions **Clinical Manifestations:** - Cytopenias - Splenomegaly **Treatment:** includes a splenectomy (surgical removal of the spleen)